tbuckley/cabot-search huggingface dataset:
Abstract 13517: Simple Noninvasive FIB-4 Index is Associated With Increased Risk for Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist CVD Learning Health System Registry
Authors: Ryan T Nguyen, Rakesh Gullapelli, Charlie Nicolas, Tamer Yahya, BUDHADITYA BOSE, Nwabunie Nwana, Shubham Lahan, Stephen Jones, Ehimen Aneni, Kershaw Patel, Ahmed Soliman, Miguel Cainzos Achirica, Eamonn Quigley, Bincy Abraham, David Victor, Khurram Nasir
Journal: Circulation (2022)

Introduction: Non-alcoholic fatty liver disease and liver fibrosis (LF) are associated with atherosclerotic cardiovascular disease (ASCVD). In this study, we aim to assess if the Fibrosis-4 index (FIB-4), a surrogate marker for liver fibrosis that is easily calculated from information within electronic medical records, is associated with composite and subgroups of ASCVD across a wide range of demographics and risk profile in a large integrated healthcare system. Methods: This cross-sectional study analyzed data on 606,056 individuals (&gt;18 years old) from the Houston Methodist Cardiovascular Disease Learning Health System Registry (June 2016-April 2022). We implemented the FIB-4 score for patients based on simultaneous presence of 4 variables (age, AST, ALT, and platelet count). LF risk was categorized according to previously described cutoffs: Low (&lt;1.3), Intermediate (1.3-2.67), and High (&gt;2.67). ASCVD (CAD, PAD, and Stroke) were identified using ICD-10-CM codes. Results: In the final study population (mean age: 54 years, 60% females, 16% Non-Hispanic Black, and 16% Hispanic adults), 27% of individuals were at moderate-risk and 8% at high-risk for LF based on the FIB-4 index. Moderate-high risk LF is associated with higher age-adjusted prevalence of both composite and subcategories of ASCVD (CAD, PAD, Stroke). Accounting for demographics, CV risk factors, and ASA/statin use, moderate and high-risk LF was associated with a 1.32 (95% CI 1.30-1.35) and 1.67 (95% CI 1.62-1.72) odds of prevalent composite ASCVD, respectively, compared to low-risk LF. Similar associations were noted for increasing LF risk and prevalence of ASCVD subcategories. Conclusions: In a large integrated health system, a moderate-high risk of liver fibrosis (based on FIB-4 index) is significantly associated with a spectrum of ASCVD conditions. FIB-4 index based early identification and management of these high-risk individuals need to be evaluated in further implementation studies.
Abstract 13607: Myocardial Tissue Characterization by Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Patients With Combined Diabetes Mellitus and Obstructive Sleep Apnea
Authors: Thiago Q Silva, Jessie Bakker, Dimitrios Baltzis, Raymond H Chan, Warren J Manning, Meredith Wallace, Carlos Gongora, Hannah Gilman, Supraja Sama, Sofia Nikolaidou, Andrei Sposito, Otavio R Coelho-filho, Margo Hudson, Michael Jerosch-Herold, Aristidis Veves, Atul Malhotra, Sanjay Patel, Tomas G Neilan
Journal: Circulation (2022)

Introduction: Overlap of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) increases the risk of heart failure possibly mediated by myocardial fibrosis. Hypothesis: T2DM+OSA overlap increases myocardial fibrosis. Methods: This was a prospective study where 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM+OSA: 57) underwent a sleep study and cardiac magnetic resonance. The measures of interest were LV and RV extracellular volume (ECV), native T1 and cardiomyocyte size (tau). Differences were tested with Kruskal-Wallis. The groups 'T2DM only' and 'OSA only' were combined (Control; T2DM or OSA; T2DM+OSA) for trend analysis with Jonckheere-Terpstra test. Results: Groups had similar sex [Control (males): 54%; T2DM: 44%; OSA only: 52%; T2DM+OSA: 65%; p=0.31)]; OSA and OSA+T2DM participants were older (46± 15; 51±7.8; 53±10; 56±9.1* # years; respectively p=0.001; *p&lt;0.05 vs. control, # p&lt;0.05 vs. T2DM only) and had higher BMI (29.8±6.3; 31±4.8; 34±6.3*; 35.2±6.6* # kg/m 2 , respectively p=0.001). LV ECV increased progressively with highest values among subjects with T2DM and OSA (0.25±0.02%; 0.27±0.03%; 0.28±0.04%; 0.31±0.05%; respectively, p=0.001; p for trend&lt;0.001). LV native T1 was similar across groups (995±91 ms; 986±112 ms; OSA: 977±132 ms; 1041±128 ms; respectively, p=0.39; p for trend=0.14), and the T2DM+OSA group had a marginally higher LV tau (0.15±0.04 s; 0.13±0.05 s; 0.12±0.04 s; 0.17±0.06 s; respectively, p= 0.05; p for trend=0.59). RV ECV (0.40±0.06%; 0.41±0.05%; 0.40±0.04%; 0.42±0.05%; respectively, p=0.70; p for trend=0.27) and RV native T1 (1105±164 ms; 1083±124 ms; 1063±189 ms; 1092±148 ms; p=0.85; p for trend=0.85) were similar. RV tau was similar but with a positive trend towards T2DM+OSA (0.087±0.029 s; 0.094±0.023 s; 0.990±0.033 s; 0.115±0.045 s; p= 0.17, p= 0.03). Conclusions: The overlap of T2DM and OSA has an incremental adverse effect on the LV ECV and may explain the increased risk of adverse cardiac events.
Abstract 14337: Cardiac Computed Tomography for Preoperative Assessment of Valve Morphology in Aortic Valve Repair
Authors: Kikuko Obase, Ichiro Matsumaru, Shun Nakaji, Takashi Miura, Kiyoyuki Eishi
Journal: Circulation (2022)

Introduction: A pre-operative assessment of aortic valve anatomy is important in valve repair for aortic regurgitation (AR). Although echocardiogram provides precise information, clear visualization of entire aortic valve and accurate quantification of valve geometry are limited even with 3D transesophageal echocardiography. In this study, usefulness of cardiac computed tomography (CT) in the evaluation of aortic valve pathology was investigated. Methods: A total of 119 patients who underwent surgical treatment for severe AR from May 2016 to July 2021 and had preoperative CT were studied. From the CT data set, volume rendering movie image was reconstructed to visualize valve anatomy. Effective height (EH) and geometric height (GH) were measured by CT in diastole and compared to intraoperative measurements. Results: The quality of CT image was satisfactory in 100 patients (84%), acceptable in 17 patients (14%) and suboptimal in 2 patients (2%). CT could visualize such detailed anatomy as shown in the Figure. EH in 41 patients and GH in 67 were measured by both CT and surgery. The measurements showed a correlation in EH (r=0.79, p&lt;0.0001) and in GH (r=0.74, p&lt;0.0001) with minimal bias of -1.6 mm in EH and 0.4 mm in GH and narrow limits of agreement from -5.9 to2.6 mm in EH and from -3.7 to 4.6 mm in GH. Inter- observer variabilities in CT measurement of EH and GH were 3.8±2.9% and 2.6±1.8%, with interclass correlation coefficients of 0.997 and 0.980, respectively. Conclusions: Reproducibility of CT measurement was excellent, while there was a little discrepancy between CT and surgical measurement. Not all cases underwent intraoperative measurement, and cases with structurally complexity tended to have surgical measurement. Some errors may be included in also intraoperative measurements. CT feasibly visualized aortic valve en-face view with showing the etiology of AR, which gave useful information to surgeons who perform aortic valve repair.
Abstract 13685: Eicosapentaenoic Acid (EPA) Inhibits Low-Density Lipoprotein (LDL) Oxidation Compared to Docosahexaenoic Acid (DHA) and Mineral Oil <i>in vitro</i>
Authors: Samuel C Sherratt, Peter Libby, Deepak L Bhatt, Preston Mason
Journal: Circulation (2022)

Introduction: Oxidized LDL triggers inflammation during the initiation and progression of atherosclerotic plaque. The omega-3 fatty acid (n3-FA) EPA administered as icosapent ethyl (IPE), reduced cardiovascular (CV) events in REDUCE-IT due, in part, to potential antioxidant and anti-thrombotic activity. By contrast, mixed n3-FA containing docosahexaenoic acid (DHA) have failed to reduce CV events in similar high-risk patients (STRENGTH). Some have raised concerns over the relationship between these discordant outcomes and placebo choice (mineral oil) as well as DHA content. We compared the effects of these compounds on oxidation of LDL where such ingested fatty acids are concentrated and transported. Methods: LDL was isolated from human plasma by isopycnic centrifugation, separated into test samples of 100 μg/mL, and incubated at 37°C for 30 min with pharmaceutical grade mineral oil, EPA, DHA or vehicle at equimolar levels (10 μM). All samples were then subjected to copper sulfate-induced oxidation (20 μM) monitored by formation of malondialdehyde (MDA). Ascorbic acid at equimolar levels served as a control. Results: LDL oxidation increased 30-fold (0.28±0.03 vs 8.72±0.54 μM; p &lt;0.001) after 4 h and the rate was unaffected by addition of mineral oil. By contrast, EPA significantly inhibited LDL oxidation; after 4 h, EPA inhibited MDA levels by 75% compared with vehicle (8.72±0.54 vs 2.20±0.36 μM; p &lt;0.001). While DHA exhibited antioxidant activity at 2 hours at a level less than EPA (1.15±0.54 vs 3.00±1.08 μM; p &lt;0.05), it exhibited no antioxidant activity after 4 h. Like DHA, ascorbic acid also reduced LDL oxidation only up to 2 h. Conclusions: These data support sustained LDL antioxidant effects for EPA compared with DHA, ascorbic acid, or mineral oil. The longer-term antioxidant actions of EPA may contribute to reduced events in outcome trials compared to mixed n3-FA formulations, independent of placebo selection.
Abstract 13476: Prevalence of Hemochromatosis in Non-Rheumatic Valvular Heart Disease and Its Effect on Prognosis: A National Cohort Analysis
Authors: Bilal Hussain, Ahmed M Mahmood, Rafael Garcia, christel cuevas, Sohail Khan, Fahad Waqar, Thomas Alexander
Journal: Circulation (2022)

Background Hemochromatosis can lead to heart failure, starting as restrictive cardiomyopathy and resulting in dilated cardiomyopathy if not treated. There is limited literature regarding whether hemochromatosis has an impact on the prognosis of non-rheumatic valvular heart disease (NRVHD). We aimed to establish the prevalence of hemochromatosis in NRVHD patients and its prognostic implications. Methods A retrospective cohort analysis was conducted with National Inpatient Sample 2016-2019. Primary outcome was the effect of hemochromatosis on prognosis of patients with NRVHD. Secondary outcomes were the independent predictors of mortality which were calculated with multivariate logistic regression analysis. Results 120,425 patients had a diagnosis of hemochromatosis with a prevalence of 0.085%, out of these 3.82% (n=4595) had NRVHD. Mean age was 65.4 years, 59% patients were males, 75% were white, and 18% were black. For individual valvular involvement, we observed that aortic valve was affected in 1.84% patients (n=2210), mitral valve in 1.82% patients (n=2195), tricuspid valve in 0.4% patients (n=485) and pulmonic valve in 0.13% patients (n=155). Hemochromatosis was associated with significantly lower odds of mortality of 53% in patients with non-rheumatic (NR) aortic valve disease (OR 0.47, CI 0.22 - 0.99, p=0.04). This association of hemochromatosis with reduction in mortality was not seen in patients with NR mitral (OR 0.49, p=0.06), tricuspid (OR 0.76, p=0.6), or pulmonary valve disease. The independent predictors of mortality in patients with hemochromatosis and NRVHD were acute liver failure (OR 5.4, p=0.05) and female gender (OR 3.7, p=0.02). Among the patients with hemochromatosis and NR aortic valve disease 8.3% underwent transcatheter while 6.1% underwent surgical aortic valve replacement. Conclusions Prevalence of hemochromatosis with co-morbid NRVHD is 3.82%. The independent predictors of mortality in this patient population are acute liver failure and female gender. Hemochromatosis is associated with 53% lower odds of mortality in patients with NR aortic valve disease. Extensive research and further studies are required to explore the possible causes for the observed reduced mortality.
Abstract 13503: Assessment of Automatic Measurement of Short-Term Variability of Repolarization for Arrhythmic Risk Monitoring in a Porcine Model of Ischemic Ventricular Fibrillation
Authors: Vera Loen, Alfonso Aranda, Jet Beekman, Marlijn S Jansen, Aina Cervera-Barea, Mathias Meine, Marc A Vos
Journal: Circulation (2022)

Background: Short-term variability of repolarization derived from the QT-interval (STV-QT) has previously been demonstrated to increase prior to arrhythmias in both humans and animals. To continuously monitor the arrhythmic risk by a cardiovascular implantable electronic device (CIED), a fully automatic method to determine STV on intracardiac electrograms (STV-EGM auto ) has been developed. This method demonstrated high effectiveness in monitoring and predicting Torsade de Pointes arrhythmias in the CAVB dog model. However, this technique has not been evaluated in arrhythmias related to ischemia yet. Purpose: To assess the novel automatic method of arrhythmic risk monitoring by CIEDs through STV-EGM auto measurements in a porcine model of ischemia-induced ventricular fibrillation (VF). Methods: Myocardial infarction was induced in 8 anesthetized pigs by balloon occlusion of the left anterior descending coronary artery for 75 minutes, followed by reperfusion. Monitoring included a 12-lead ECG and a duodecapolar EGM catheter in the right ventricle. STV-EGM auto and STV-QT, our gold standard calculated by the method of fiducial segment averaging, were assessed at baseline, occlusion, one minute before VF and just before VF. The STV values and the percentual changes from baseline to the successive three timepoints were compared between STV-EGM auto and STV-QT. Results: VF occurred 21±8.8 minutes after occlusion. Both STV-EGM auto and STV-QT increased significantly from baseline to VF (1.1±0.8 ms vs 2.4±1.5 ms, p&lt;0.05; 1.0±0.5 ms vs 2.2±0.9 ms, p&lt;0.05, respectively). The percentual change in STV-EGM auto from baseline to occlusion, one minute before VF and VF showed an excellent correlation with the changes in STV-QT from baseline to the successive timepoints (r 2 = 0.94; p&lt;0.001). Bland-Altman analysis of the values showed a small bias of 0.26 ms and 95% limits of agreement between -1.1 and 1.6 ms. Conclusion: The STV values derived from the fully-automatic method for continuous STV measurements on intracardiac EGM signals (STV-EGM auto ) show values and trends similar to the clinically validated STV-QT in a porcine model of ischemia-related VF. Future integration of this technique in CIEDs can furnish continuous monitoring of arrhythmic risk.
Abstract 13067: Chronic Ischemic Heart Failure Defines Immune Cell Activation Signatures From ScRNA-seq and Flow Cytometry With Implications for Cardiac Resident Cells
Authors: Maximilian Merten, Tina Rasper, Bianca Schuhmacher, Sebastian Cremer, Jedrzej Hoffmann, Andreas M Zeiher, Stefanie Dimmeler, Wesley T Abplanalp
Journal: Circulation (2022)

Adverse remodelling and sustained inflammation are key features of chronic ischemic Heart Failure (HF) with reduced ejection fraction. The importance and role of monocytes and T cells in early stages after myocardial infarction are known, however their role in progression of chronic HF remains elusive. Single cell RNA sequencing of peripheral immune cells from healthy and HF donors was performed to gain insights into these altered immune profiles, revealing an increase of activated T cells in HF together with an enrichment of antigen presenting molecules (incl. HLA-DRB5) and co-stimulatory molecules (ICAM-1) on antigen presenting cells. Validation via flow cytometry in 55 young healthy controls and 110 HF patients confirmed elevated HLA-DRB5 levels in HF derived monocytes, which was positively correlated with both ICAM-1 and TREM-1 (p=0.0001 for both), indicating T cell activation induction. Accordingly, significant increases in activated CD4+ and CD8+ T cells (p=0.0001 for both) were observed in HF. Also, increasing relative TCR clonality from T cell receptor (TCR) sequencing of HF patients and age matched controls suggests that circulating T cells expanded. Examination of potential downstream effects of the enhanced immune cell activation was done by measuring the serum of HF patients, showing increases in sICAM-1, IL-6 and TNFRI levels (1.75x-, 5.30x-, 2.63x-fold respectively). This secretome of HF patients was applied to endothelial cells to study direct effects, revealing increased adhesion capacity to co-cultured monocytes. Additionally, these HF secretome-exposed endothelial cells had decreased levels of the checkpoint inhibitor PD-L1 which is known to block autoimmune activity by T cells. Taken together, these data suggest HF is associated with enhanced monocyte and T cell activation as well as T cell clonal expansion. These processes may disturb resolution of inflammation in the cardiac tissue and lead to adverse remodelling and cardiac damage. More data are needed to assess the specific role of chronic monocyte and T cell activation in the progression of heart failure.
Abstract 12774: Detecting Change in Cardiopulmonary Bypass Blood Flow Rate With a Novel, Wireless, Wearable Doppler Ultrasound Patch: A Pilot Study
Authors: Chelsea E Munding, Jon-Emile S. S Kenny, Zhen Yang, Geoffrey Clarke, Mai Elfarnawany, Andrew M Eibl, Joe K Eibl, Bhanu Nalla, Rony Atoui
Journal: Circulation (2022)

Introduction: Assessing preload reserve (PR) is important when managing cardiac surgery patients. Typically, a 10% change in cardiac output is used as a reference standard to gauge PR; how this change in cardiac output translates to common carotid artery (CCA) velocity is unknown. In this pilot study, we compared known changes in cardiopulmonary bypass (CPB) flow rate to those measured by a novel wireless, wearable Doppler ultrasound placed over the CCA. Methods: A sample of 14 adult patients undergoing elective CABG was studied. While on CPB, at least two changes in blood flow (one negative, one positive) were made. The corresponding change in CCA velocity was measured by a wearable continuous wave (CW) Doppler ultrasound patch. For each subject, CPB flow changes were determined from the displayed spectrogram by the peristaltic pulsation frequency and CCA velocity changes were calculated from the automated maximum velocity trace. 5-10s windows pre- and post-CPB speed changes were selected, with sufficient signal quality to determine both relative CPB flow and CCA velocity. A “dose-response” curve was fitted to the relative changes in flow and velocity for each subject, as shown in Fig. 1, and the CCA velocity change corresponding to a 10% change in CPB flow was calculated. Results: CPB flows ranged from 0.5-6.3L/min. Mean relative flow changes were -58 and 179%, corresponding to mean CCA velocity changes of -43 and 107%. A mean CCA velocity change of 14% was found to correspond to 10% CPB flow change, ranging from 1.5-27.8%. Conclusions: CCA velocity measured with the Doppler patch successfully tracked changes in CPB flow. A CCA velocity change of &gt;14% suggests a &gt;10% change in cardiac output. Although preliminary, these results provide another important parameter for predicting the response to preload using a novel, easy-to-use, wireless Doppler device.
Abstract 13637: Advanced Multimodality Imaging of Atrial Baffle Leak After the Senning Operation
Authors: Sarah E Kollar, Michelle Udine, Anita Krishnan, Yue-Hin Loke, Seiji Ito
Journal: Circulation (2022)

Description of Clinical Presentation We present a 40-year-old male with dextro-transposition of the great vessels and history of a Senning repair as an infant and a transvenous dual-chamber pacemaker at 7 years of age for sinus node dysfunction. Advanced imaging, including cardiac computed tomography (CT) and cardiac magnetic resonance (CMR), were performed as routine testing to evaluate the baffle and ventricular function. Diagnostic Testing and Their Most Important Findings: An ECG-gated cardiac CT demonstrated multiple defects between the systemic and pulmonary venous baffle (1A). CMR demonstrated a severely dilated right ventricle with moderately depressed systolic function, mild tricuspid valve insufficiency, and a moderately dilated, hyperdynamic left ventricle (LV). Advanced 4D flow confirmed a pulmonary to systemic blood flow ratio of 2.8:1, with large left-to-right shunt corresponding to the defects noted on CT (1B). There was no evidence of systemic or pulmonary venous baffle obstruction. 3D transesophageal echocardiography (echo) demonstrated multiple deficiencies in the septal/posterior atrial flap (1C). A stenotic, bicommissural pulmonary valve with moderate flow acceleration was also noted. 3D modelling from the CT/CMR data further clarified the location of the baffle leaks relative to pacemaker leads (1D). Cardiac catheterization confirmed these findings of large left-to-right shunt. Learning Points from this case: Atrial switch patients have a significant risk for baffle leaks, which can be challenging to identify. Advanced imaging including CT, CMR, 3D modeling, 3D echo, and cardiac catheterization are complimentary in the diagnosis of baffle leaks and can guide therapeutic options.
Abstract 13686: HEART Score Predicts Coronary Artery Disease on Coronary Computed Tomography Angiography in the Emergency Department Only in Patients With Three or Greater Risk Factors
Authors: Abdallah Masri, Abdelrahman Masri, Saurabh Malhotra
Journal: Circulation (2022)

Introduction: HEART (History, Electrocardiogram, Age, Risk factors, Troponin) Score (HS) predicts MACE in patients presenting to the ED with chest pain. It was validated clinically but not radiologically. Coronary computed tomography angiography (CCTA) in the ED allows for rapid triaging of patients and carries prognostic value. Objective: study relationship between HS and the presence and severity of CAD on CCTA. Methods: In this retrospective cohort, we included patients undergoing CCTA in the ED for acute chest pain between January 2014 to July 2016. HS was calculated and classified as low-risk (score &lt;=3) or high-risk (score &gt;3). A certified specialist reviewed all CCTA studies and determined the presence and severity of CAD. Anatomic CAD was defined by coronary artery calcium score (CACS) &gt;0 or the presence of any stenosis. Obstructive CAD was defined by CACS&gt;100 or coronary stenosis &gt;=50%. Multivariate regression analysis was performed to determine predictors of anatomic and obstructive CAD. We performed interaction analysis between HS and the presence of &gt;=3 traditional CAD risk factors. Results: Of the 927 CCTA performed, 315 (34%) had anatomic CAD, 128 (14%) had obstructive CAD. Mean age was 51 years, 49% were males, mean HS was 2.6, and 71% of the cohort had a low-risk HS. High HS was associated with higher proportions of CAD only in patients who had &gt;=3 traditional CAD risk factors [Fig 1]. Regression and interaction analyses showed that HS was an independent predictor of anatomic and obstructive CAD only in patient with &gt;=3 traditional CAD risk factors [Fig 2]. Conclusion: HS is a predictor of radiographic CAD on CCTA when performed in patients with &gt;=3 traditional risk factors.